Cardiovasc Diagn Ther 2016;6(3):241-249.
Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis
Sameer Arora1,2, Jacob A. Misenheimer3, Wesley Jones1, Amol Bahekar2, Melissa Caughey3, Cassandra J. Ramm3, Thomas G. Caranasos3, Michael Yeung3, John P. Vavalle3
1Campbell University School of Osteopathic Medicine, Lillington, NC, USA; 2Cape Fear Valley Medical Center, Fayetteville, NC, USA; 3University of North Carolina, Chapel Hill, NC, USA
Background: Transcatheter aortic valve replacement (TAVR) has been approved in patients with high or prohibited surgical risk for surgery for treatment of severe symptomatic aortic stenosis. Prospective studies examining the benefits of TAVR in intermediate risk patients are ongoing. Other smaller studies including lower risk patients have been conducted, but further meta-analysis of these studies is required to draw more broad comparisons.
背景：经导管主动脉瓣置换术（Transcatheter aortic valve replacement，TAVR）已经被应用于治疗高危或有外科禁忌的严重主动脉瓣狭窄的患者。关于TAVR在中危患者中收益的前瞻性研究一直都在进行。其他一些小规模的研究已经取得了结果，例如较低危险患者在TAVR中的收益的前瞻性研究，但仍需要进一步的荟萃分析才能得到更为全面的比较分析结果。
Methods: A Medline search was conducted using standard methodology to search for clinical trials and observational studies including intermediate risk patients. We limited our meta-analysis to studies matching patient populations by propensity scores or randomization and examined clinical outcomes between TAVR and surgical aortic valve replacement (SAVR).
方法：使用标准的检索方法在Medline数据库中检索所有中危患者的临床试验和观察性研究，随后挑选倾向分数配对或随机法匹配的临床研究患者进行meta分析，比较其TAVR和外科主动脉瓣置换术(surgical aortic valve replacement , SAVR)的临床结果。
Results: Analysis of the TAVR and SAVR cohorts revealed no significant differences in the outcomes of 30-day [OR (95% CI): 0.85 (0.57, 1.26)] or 1-year mortality [OR (95% CI): 0.96 (0.75, 1.23)]. A trend towards benefit with TAVR was noted in terms of neurological events and myocardial infarction (MI) without statistical significance. A statistically significant decrease in risk of post-procedural acute renal failure in the TAVR group [OR (95% CI): 0.52 (0.27, 0.99)] was observed, but so was a significantly higher rate of pacemaker implantations for the TAVR group [OR (95% CI): 6.51 (3.23, 13.12)].
结果：分析结果表明术后30天的临床结果在TAVR队列和SAVR队列间无显著性差异[优势比(95%置信区间):0.85 (0.57, 1.26)]。而且，术后1年死亡率在TAVR队列和SAVR队列之间也未达到统计学上的显著性差异[优势比(95%置信区间):0.96(0.75, 1.23)]。TAVR较SAVR有减少神经病学事件和心肌梗死的趋势，但无统计学上的显著性意义。而且，与SAVR相比较，TAVR能够显著地减少术后急性肾衰竭的风险，并具有统计学意义[优势比(95%置信区间):0.52(0.27, 0.99)]，但是TAVR使起搏器植入率明显增加[优势比(95%置信区间): 6.51 (3.23, 13.12)]。
Conclusions: We conclude that in intermediate risk patients undergoing aortic valve replacement, the risk of mortality, neurological outcomes, and MI do not appear to be significantly different between TAVR and SAVR. However, there appears to be a significant reduction in risk of acute renal failure at the expense of an increased risk of requiring a permanent pacemaker in low and intermediate risk patients undergoing TAVR compared to SAVR.
Keywords: Transcatheter aortic valve replacement (TAVR); aortic stenosis; surgical risk; surgical aortic valve replacement (SAVR)
Cardiovascular Diagnosis and Therapy (http://cdt.amegroups.com/index) is a bi-monthly, open-access, peer-review journal, which accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The journal was launched in December 2011 and published by AME Publishing Company. CDT is relatively new, yet it has a great potential with an international editorial board. Now, it has been accepted into PubMed, PMC and ESCI.